The 10 Most Addictive Substances to Avoid | The Doctor Weighs In

By: Ahmed Howeedy, MD

Opiates are only one of a number of substances that have very high rates of addiction. Here are the 10 most addictive substances that you should avoid.

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Photo Sorce: Deposit

But opiates are only one of a number of addictive substances that have high rates of addiction, a potentially life-threatening medical condition that requires immediate treatment.

Here are the 10 most addictive substances to avoid for the sake of your health:

Also known as “ speed,” amphetamines stimulate the central nervous system (CNS), by triggering the release of the “pleasure neurotransmitter” dopamine. Users experience an intense rush of energy, excitability, and pleasure when the drug activates their brain’s “reward pathway.”

Tolerance builds rapidly, requiring addicts to constantly increase their dosage. And putting themselves at greater risk of psychosis. (At high doses, amphetamines are associated with psychotic episodes.) Commonly used doctor-prescribed amphetamines include Adderall, Ritalin, and other ADD/ADHD medications.

Benzodiazepines such as Valium and Xanax are typically prescribed to treat anxiety, insomnia, alcohol withdrawal, and other conditions. Though they work well for their intended uses, “ benzos,” as they are commonly called, can be highly addictive.

In fact, the National Institute on Drug Abuse has linked the short half-life of many benzos to higher risks of dependency and tolerance. This tolerance build-up can happen in as little as six weeks, potentially leading to addiction in quick time.

Methadone is a very powerful synthetic opiate that blocks the effects of heroin and other prescription drugs that contain opiates. It is commonly prescribed to treat heroin addiction. The problem with methadone, however, is that it can be as addictive (if not more addictive) than heroin, and is even harder to detox from.

Nicotine, most often seen in tobacco products like cigarettes, acts in much the same way that other addictive drugs do. That is by triggering a surge of endorphins in the brain’s reward system.

That pleasure surge is milder and shorter-acting than it is with other drugs (you can learn more about nicotine cravings here). But that doesn’t mean nicotine is less addictive or better for your health than other addictive substances. On the contrary, studies have shown that tobacco use is the leading preventable cause of disease, disability, and death in the United States.

Because alcohol is legal and largely socially accepted, it can be easy to underestimate its addictive dangers. But alcohol acts as a central nervous system depressant. This means that it reduces anxiety and relaxes users, loosening their inhibitions. Alcohol also hampers the users’ ability to make proper judgments and perform motor movements.

When you consume alcohol, your brain releases dopamine and endorphins, which produce feelings of satisfaction and eliminate feelings of pain. Over time, however, your body will need more and more alcohol in order to achieve these same effects.

Cocaine is a stimulant drug. It causes dangerous physical effects such as rapid heart rate and increased blood pressure. It’s extremely addictive due to its short half-life and mechanisms of action. Cocaine sends a flood of dopamine to the brain, creating its signature “ high.”

Withdrawal soon sets in after this initial fleeting rush, leaving brain and body in a state of intolerable discomfort- hence the cravings that lead to addiction.

“Crack,” is made from a mixture of baking soda and powder cocaine. It is a smokable version of cocaine (which in its pure powder form is usually snorted).

Smoking crack produces a faster, more intense, and extremely short-lived high. This causes users to crave more and more of the drug.

Heroin is widely considered to be the most addictive drug in the world. In fact, studies have shown that just one dose of heroin can put a person on the path to addiction.

Heroin causes euphoria, eases pain, and numbs the brain and body by acting on an area of nerve cells within the central part of the brain known as the nucleus accumbens. These effects make it one of the most popular drugs of abuse.

“MDMA,” also known as ecstasy or “Molly,” is a synthetic, psychoactive drug. The National Institute on Drug Abuse has described it as chemically similar to both stimulants and hallucinogens. The result is that users experience a multidimensional euphoria, characterized by increased energy, emotional warmth, pleasure, and distorted sensory and time perceptions.

Studies have shown that MDMA damages serotonin-containing neurons, and sometimes the damage is long-lasting.

“OxyContin,” which is the brand name for oxycodone, is a potent synthetic opiate. Similar to heroin, OxyContin produces a euphoric high that is caused by stimulation of the brain’s reward center. OxyContin elevates levels of dopamine, the pleasure chemical of the brain; yet in order to keep these feel-good chemicals elevated in the brain, more and more of the drug is required.

The same dynamic occurs with the opiate painkiller fentanyl- only to a greater degree because of fentanyl’s much higher potency than OxyContin. (Fentanyl is 50 to 100 times more potent than morphine, which is 1.5 times more potent than OxyContin.) In recent years, fentanyl has overtaken OxyContin as the main culprit for overdose deaths attributed to prescription painkillers.

Getting Help for Addiction

Using any of the above highly addictive substances is a dangerous proposition because it puts you at risk of developing a life-threatening substance use disorder. The good news is that addiction is a treatable condition. And, that anyone with addiction(s) to one or more of these 10 most addictive drugs can achieve recovery.

As the medical director for a behavioral health provider, I get to see this reality firsthand.

With detox and rehab treatment, you can live a life without drugs and alcohol.

If you are using heroin, cocaine or any other substance that’s destroying your health and relationships, contact the Substance Abuse and Mental Health Services Administration’s National Helpline at 1–800–622-HELP.

Editor’s note: You can find all of the articles we have published on Substance Abuse and Addiction here

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Dr. Ahmed Howeedy is Chief Medical Officer at FHE Health a Florida-based behavioral health provider. He obtained his medical degree at the University of South Florida in Tampa, where he was the recipient of a USF College of Medicine Scholarship. At USF, he was inducted into the College of Medicine Gold Humanism Honor Society. He holds an undergraduate degree in microbiology and immunology from the University of Miami where he graduated cum laude. At FHE Health, Dr. Howeedy oversees the implementation of a “collaborative care model” that integrates medicine and behavioral health. He also trains area nurse practitioners and physician assistants in the field. Addiction treatment plans are available at FHE Health.

Originally published at on June 4, 2019.

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